Psychosis

Psychosis (sy-KO-sis) is a broad term covering a range of mental
illnesses associated with a loss of connection to reality. Illnesses
that involve psy chosis may severely impair a person's ability to
relate to other people and to perform basic tasks of daily life.

KEYWORDS

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Delusions

Dementia

Hallucinatlons

Schizophrenla

What Is Psychosis?

"Psychosis" is a medical term used to describe serious
mental disorders that cause a person to lose touch with reality. People
with psychosis may have
delusions
*
, hallucinations
*
, or dementia
*
; they may lose the ability to speak coherently or to understand what
others say to them; and their thoughts, feelings, and behaviors may be
inappropriate and disconnected from the reality around them without their
being aware of the disconnection.

Disorders associated with psychotic symptoms

In some cases, psychosis lasts only for a few days or weeks (acute or
brief psychosis), but sometimes it is a chronic
*
condition. Some of the disorders associated with psychosis include:

Schizophrenia (SKIT-zo-free-nee-a) and related conditions, including
brief psychotic disorder and schizophreniform (SKIT-zo-fre-ni-form)
disorder, which are characterized by hallucinations or delusions and may
lead to problems in daily functioning.

Serious mood disorders, for example major depression or bipolar disorder
with psychotic features.

Alzheimer disease, a progressive disorder that affects the brain, most
often in older adults, that usually causes dementia.

Alcoholism, which causes many physical problems including liver disease
and delirium tremens, a temporary condition involving hallucinations,
delusions, fears, sweating, and discomfort, which typically occurs in
the first few days after people with alcoholism stop drinking
completely.

Seizure disorders, which may temporarily disrupt the electrical patterns
in the brain and the thought processes controlled by brain cell
activity.

Postpartum psychosis, a disorder that sometimes affects women who
recently have given birth.

Substance abuse, particularly relating to use of opiates, steroids, and
hallucinogens like PCP and LSD.

Treatment

Psychosis is a sign of serious illness, and people with psychosis must be
thoroughly evaluated and should receive appopriate medical treatment.
Treatment often involves medication and psychotherapy and sometimes
requires that a patient be hospitalized.

*
delusions
(duh-LOO-zhunz) are beliefs that are false and have no basis in
reality. People may think, for example, that someone is trying to harm
them or that they have great importance, power, wealth, intelligence, or
ability.

*
hallucinations
(huh-LOO-sin-NAY-shunz) are sensory perceptions without a cause in the
outside world. People may hear voices or see things that are not really
there.

*
chronic
(KRAH-nik) means lasting a long time or recurring frequently.

Medical treatment for people with psychosis has improved greatly in recent
years. Safer and more effective medications have been developed. There
also have been many reforms to the laws that safeguard the rights and
freedoms of people with mental illnesses, so that they no longer can be
hospitalized against their will without a fair hearing and legal
representation.

Cultural Beliefs About
Mental Illness

The fact that definitions of psychosis and mental illness have changed
over the years has led to debate about whether mental illness really
exists.

The astronomer Galileo Galilei (1564-1642), for example, was considered
to be mentally ill because he believed that the earth revolved around
the sun during an era in which everyone else in his culture believed the
opposite. Galileo's belief threatened the religious institutions
of his day, and he was called before the Inquisition in 1633 and was
asked to abandon his belief. When he refused to do so, he was condemned
for heresy and held under house arrest for the last nine years of his
life. Galileo was not mentally ill. Galileo understood that his culture
did not accept his belief, but his personal commitment to scientific
reality was more important to him than acceptance by his contemporaries.

British psychiatrist R D. Laing (1927-1989) believed that mental illness
was a form of withdrawal from reality that people chose when they no
longer could tolerate situations that other members of their family or
society found acceptable. He thought that "mental illness"
was a sane response to an insane world. Laing believed that
psychiatrists sometimes diagnosed mental illness when the true problems
were in fact rebellion and a refusal to live in an unlivable situation.
Laing's publications include
Sanity, Madness, and the Family; Self and Others; The Divided Self
and
The Politics of Experience.

American psychologist Thomas Szasz (b. 1920) believes that mental
illness is a metaphor for thoughts, feelings, and behaviors of which
society disapproves. His well-known book
The Myth of Mental Illness
holds that society uses "mental illness" as a label to
control people, forcing them to accept unwanted treatment and
hospitalization. Dr. Szasz believes that all medical treatment must be
voluntary.

While it is certainly true that medical diagnoses sometimes have been
misused for social control, most mental health professionals today do
not agree with Laing and Szasz that mental illness is a myth, metaphor,
or chosen response. To believe this would be to deny a biological basis
for many instances of mental illness and to deny the pain,
disorientation, and fear that people with mental illnesses experience.

People with psychosis are seriously ill with medical conditions that
affect their thoughts, feelings, and ability to understand reality,
sometimes even the reality that they need medical treatment. In fact,
many patients later thank those who insisted they receive treatment,
because when they recover they recognize that their illness had been
affecting their thinking.

Thomas Szasz, author of
The Myth of Mental Illness,
believes that people should not be hospitalized without consent and
that "insanity" should not be used as a defense in
courts of law.

AP Laserphoto

Psychosis and the "Insanity Defense"

Our legal system rests on the notion of personal responsibility. To find a
person guilty of a crime requires proof that the person committed the
crime and that he or she can be found blameworthy. When might a person not
be found at fault? One clear case where the law allows for a verdict of
innocence, even when a crime has been committed, is when the crime was
done in self-defense. The other extreme circumstance that might
"excuse" a crime often is called the "insanity
defense."

John Hinckley, Jr., tried to assassinate President Ronald Reagan in
1981. In 1982, a Washington, D.C., jury determined that he was
"not guilty by reason of insanity."

Ted Streshinsky/Corbis

Psychosis
is a medical term involving illnesses that cause people to lose touch
with reality.
Insanity
is a legal term used to determine whether there are some mental states
that limit people's ability to understand their actions so severely
that they cannot be held accountable for those actions. Legal tests for
determining sanity during court trials using the insanity defense usually
focus on whether the people on trial understood what they were doing when
they committed crimes, understood the difference between right and wrong,
and were able to control their own behavior.

At present, the legal test for insanity varies from location to location.
Some states use the British "M'Naghten Rule," named
after Daniel M'Naghten, who attempted a political assassination in
England in 1843. Other states use the American Law Institute (ALI) Test,
also called the Model Penal Code. The ALI test was used during the 1982
trial of John Hinckley, Jr., who attempted to assassinate President Ronald
Reagan in 1981. When Hinckley was found "not guilty by reason of
insanity," a political backlash occurred, and the U.S. Congress
introduced the legal concept of "guilty, but mentally ill."

The American Psychiatric Association (APA), the medical group that
publishes standards for classifying mental illnesses and supports research
about their treatment, does not use the legal term
insanity.
The APA maintains that psychiatrists may testify in court to help trial
participants understand mental illness and psychosis, but that questions
of innocence, guilt, and moral responsibility need to be left to judges
and juries.

Resources

Organizations

U.S. National Institute of Mental Health, 6001 Executive Boulevard, Room
8184, MSC 9663, Bethesda, MD 20892-9663. This division of the National
Institutes of Health oversees research on mental disorders and provides
information for professionals and the public.
Telephone 301-443-4513
http://www.nimh.nih.gov

American Psychiatric Association, 1400 K Street NW, Washington, DC
20005. An organization of physicians that publishes the
Diagnostic and
Statistical Manual of Mental Disorders,
a guide to the definitions of various disorders. This group also
publishes the
Let's Talk Facts
pamphlet series for the public.
Telephone 888-357-7924
http://www.psych.org

American Academy of Psychiatry and the Law, P.O. Box 30, One Regency
Drive, Bloomfield, CT, 06002-0030. This organization promotes scientific
and educational research in how psychiatry is applied to legal issues
(forensic psychiatry).
Telephone 800-331-1389
http://www.aapl.org

National Alliance for the Mentally Ill, Colonial Place Three, 2107
Wilson Blvd., Suite 300, Arlington, VA 22201-3042. An information,
advocacy, and support organization for people with serious mental
illnesses and their families and friends.
Telephone 800-950-NAMI or 703-524-7600
http://www.nami.org